Ab1387 a Rare Cause of Pes Anserine Bursitis: Tibial Exostosis: Three Case Reports

Abstract

BackgroundPes anserine bursitis is a syndrome causing pain at the medial knee and the proximal medial tibia [1]. Sartorius, gracilis, and semitendinous tendons attach 5 cm distal to the medial knee joint line taking a shape is called pes anserinus. It is more common obese females with knee osteoarthritis between 50-80 years of age [1]. Rarely, tibial bone spurs present as rose thorns and cause pes anserinus bursitis and knee pain [2].ObjectivesIn this case report, we presented proximal tibial exostosis which randomly detected and resulting to pes anserinus syndrome in three patients.MethodsCase 1 (NB): A 58-years-old female patient was admitted to our outpatient clinic with right knee pain. She had pain for 2 months, increasing with standing and walking. In the physical examination, she did not describe any trauma, the area where the pes anserinus tendons attached to medial proximal tibia was painful. There was no swelling and redness on the skin. A bone spur from the proximal tibial metaphysis was seen in the right knee on direct radiography (Figure 1).Case 2 (BE): A female who 22 years-old, was admitted to our outpatient clinic with left knee pain, which was for 5 months. The skin appearance above the knee was normal. There was no swelling. Medial left proximal tibia was tender with palpation. Physical examination was normal. The blood tests of the patient were completely normal. A spur like as a rose thorn forming from the proximal tibial region was observed in the left knee, similar to the first case, on the direct radiography (Figure 2).Case 3 (GB): A 64-year-old female patient was admitted to our outpatient clinic with pain in the medial left knee. Her complaint was present for 6 months. There was no history of trauma. Knee joint range of motion was normal. There was no effusion in knees. Mc-Murray test was negative. There was a minimal sweelling and tenderness on pes anserine region. A bone exostosis was observed in the left medial tibia on the direct radiography requested from the patient.ResultsThe Case 1 was told to rest for two weeks and not to walk much. Non-steroidal anti-inflammatory drug therapy and 10 minutes cold application to the knee per 6 hours were recommended. At the follow-up one month later, the visual analog scale (VAS) score was regressed from 7 to 2. Non-steroidal anti-inflammatory drug was started to Case 2 and activity restriction was recommended. At the follow-up two weeks later, VAS score decreased from 6 to 4. 1 ml of methylprednisolone was injected locally to the pes anserinus region of Case 3. One month later, the patient’s VAS score decreased from 7 to 1.ConclusionRarely, pes anserine bursitis may be accompanied by medial tibial exostosis. The clinicians must be keep in mind proximal tibial spurs in patients presenting with knee pain and pes anserinus bursitis.References[1]Mohseni M, Mabrouk A, Graham C. Pes Anserine Bursitis. 2022 Nov 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan- 2022 Nov 23.[2]Tiwari V, Kumar VS, R Poudel R, Kumar A, Khan SA. Pes Anserinus Bursitis due to Tibial Spurs in Children. Cureus 2017;9(7):e1427. doi: 10.7759/cureus.1427.Figure 1.Figure 2.AcknowledgementsNone.Disclosure of InterestsNone Declared.